1 Quality Health Indicators Brought to you by… Left click mouse or use down arrow to proceed through this presentation

2 About QHi The PiHQ Portal Defining your facility Selecting Measures Entering Data Dashboards Reports How we use the data Select any menu item above to go directly to a topic or Click to continue through the presentation Main Menu

3 Quality Health Indicators The Quality Health Indicator (QHi) web site was developed through the Kansas Hospital Association (KHA) and the Kansas Rural Health Options Project (KRHOP) to facilitate a benchmarking project for rural Kansas hospitals. The goal of QHi is to provide hospitals an economical instrument to evaluate internal processes of care and to seek ways to improve practices by comparing specific measures of quality with like hospitals. Using QHi as a tool, regional networks of hospitals and individual facilities can select from a library of indicators to determine which measures meet their unique needs.

4 Quality Health Indicators More than 1000 users in over 295 Critical Access and other small rural hospitals in Arizona, California, Colorado, Illinois, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Missouri, Nebraska, New Mexico, Oklahoma, Oregon and Wyoming use QHi as a data collection and benchmarking tool. As a user-driven multi-state project, QHi is well-positioned to serve as a significant repository of information on quality of care and performance in rural hospitals nationwide.

5 Four Pillars Of Measurement Quality Health Indicators Clinical Quality Employee Contribution Patient Satisfaction Financial Operational

6 QHi Core Measures Set Clinical Quality Healthcare Associated Infections per 100 inpatient days Unassisted Patient Falls per 100 inpatient days Pneumococcal Immunization – Age 65 and Older (CMS IMM-1b) Discharge Instructions (CMS HF-1) Employee Contribution Benefits as a Percentage of Salary Staff Turnover All participating hospitals are asked to collect and report the 8 QHi Core Measures: Financial Operational Days Cash on Hand Gross Days in AR

7 Clinical Quality Measures Inpatients Screened for Pneumonia Vaccine Status (not a CMS measure) Medication Omissions Resulting in Medication Errors per 100 inpatient days Medication Errors Resulting from Transcription Errors per 100 inpatient days Percentage of ER Provider Response Times Percentage of Return ER Visits within 72 hours with same/similar diagnosis Percentage of Readmissions Within 30 Days with Same or Similar Diagnosis Healthcare Associated Infections per 100 inpatient days* Unassisted Patient Falls per 100 inpatient days* Long Term Care Patient Falls per 100 Long Term Care patient days CMS Pneumonia Measures: Inpatients Receiving O2 Assessment within 24 hours of admission - CMS PN-1 (retired) Inpatients Receiving Pneumococcal Vaccination - CMS PN-2 (retired) Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital - CMS PN-3b Adult Smoking Cessation Advice/Counseling - CMS PN-4 (retired) Pneumonia Patients Receiving Initial Antibiotic Within 6 Hours of Hospital Arrival - CMS PN-5c (retired) Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients - CMS-PN6 Influenza Vaccination - CMS PN-7 (retired) *Part of the 8 Core Measure Set Additionally, facilities can select from over 100 measures in the QHi library of indicators:

Clinical Quality Measures (continued) CMS OP Transfer Measures: Median Time to Fibrinolysis in the Emergency Department - CMS OP-1 Fibrinolytic Therapy Received Within 30 Minutes of ED Arrival in the Emergency Department - CMS OP-2 Median Time to Transfer to Another Facility for Acute Coronary Intervention in the Emergency Department - CMS OP-3 Aspirin at Arrival in the Emergency Department - CMS OP-4 Median Time to ECG in the Emergency Department - CMS OP-5 Timing of Antibiotic Prophylaxis in Hospital Outpatient Surgery - CMS OP-6 Prophylactic Antibiotic Selection for Surgical Patients in Hospital Outpatient Surgery - CMS OP-7 CMS Immunization Measures: Pneumococcal Immunization – Overall Rate - CMS IMM-1a Pneumococcal Immunization – Age 65 and Older* - CMS IMM-1b Pneumococcal Immunization – High Risk Populations (Age 5 through 64 years) - CMS IMM-1c Influenza Immunization - CMS IMM-2 *Part of the 8 Core Measure Set 8

Clinical Quality Measures (continued ) CMS HF Measures: Discharge Instructions* – CMS HF-1 Evaluation of LVS Function – CMS HF-2 ACEI or ARB for LVSD – CMS HF-3 Adult Smoking Cessation Advice/Counseling – CMS HF-4 (retired) CMS SCIP Measures: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision – Overall Rate CMS SCIP-Inf-1a Prophylactic Antibiotic Selection for Surgical Patients – Overall Rate CMS SCIP-Inf-2a Prophylactic Antibiotics Discontinued Within 24 Hours after Surgery End Time – Overall Rate CMS SCIP-Inf-3a Surgery Patients with Appropriate Hair Removal – CMS SCIP-Inf-6 Urinary Catheter Removed on Postop Day 1 or Postop Day 2 with Day of Surgery being Day 0 – CMS SCIP-Inf-9 Surgery Patients with Perioperative Temperature Management – CMS SCIP-Inf-10 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period – CMS SCIP-Card-2 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered – CMS SCIP-VTE-1 (retired) Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery – CMS SCIP-VTE-2 *Part of the 8 Core Measure Set 9

Clinical Quality Measures (continued) MBQIP Phase 3 Measures: Pharmacist CPOE/Verification of Medication Orders Within 24 Hours Outpatient Emergency Department Transfer Communication (Pre-Transfer Communication Information) Outpatient Emergency Department Transfer Communication (Patient Identification) Outpatient Emergency Department Transfer Communication (Vital Signs) Outpatient Emergency Department Transfer Communication (Medication-related Information) Outpatient Emergency Department Transfer Communication (Practitioner generated information) Outpatient Emergency Department Transfer Communication (Nurse generated information) Outpatient Emergency Department Transfer Communication (Procedures and Tests) 10

11 Employee Contribution Measures Non-Nursing Staff Turnover Average Time to Hire (All Staff) Nursing Staff Turnover Average Time to Hire (Nursing) Average Time to Hire (Non-Nursing) Salary to Operating Expenses Comparison Benefits as a Percentage of Salary* Staff Turnover* Patient Satisfaction Measures How well staff worked together to care for the patient (QHi1) The extent to which the patient felt ready for discharge (QHi2) In addition to these two original QHi patient satisfaction measures, 25 HCAHPS measures are now in the library of indicators. *Part of the 8 Core Measure Set Hospital Characteristics Measures Average Inpatient Days ALOS (in hours) Comparison

12 Financial: Days Cash on Hand* Gross Days in AR* Net Days in Accounts Receivable Bad Debt as a % of Gross Patient Revenue Charity Care as a % of Gross Patient Revenue Bad Debt and Charity Care as a % of Gross Patient Revenue Cost per Adjusted Patient Day Labor Hours per Adjusted Patient Day Labor Cost per Adjusted Patient Day Labor Cost as a % of Net Patient Revenue Net Patient Revenue as a % of Gross Patient Revenue Financial & Operational Measures Bad Debt Expense Charity Care Cost per Patient Day Labor Hours per Patient Day Operating Profit Margin Total Margin Total Margin % Debt Service Coverage Ratio Current Ratio Net Patient Revenue per Adjusted Patient Day Net Patient Revenue per Patient Days *Part of the 8 Core Measure Set

Financial & Operational Measures (continued) Operational: Physical Therapy Paid Labor Hours per UOS Laboratory Paid Labor Hours per UOS X-ray Paid Labor Hours per UOS Mammogram Paid Labor Hours per UOS Ultrasound Paid Labor Hours per UOS CT Paid Labor Hours per UOS MRI Paid Labor Hours per UOS Pharmacy Paid Labor Hours per UOS Nursing Hours per Acute Inpatient Day Nursing Hours per Patient Day Rural Health Clinic Encounters per FTE Long Term Care Hours per LTC Patient Day Laboratory Hours per Billed Service 13 Financial (continued): Payer Mix – Commercial Payer Mix – Medicaid Payer Mix – Medicare Payer Mix – Other Payer Mix – Other Government Payer Mix – Self/Private Pay Acute Occupancy per Day Swing Bed Occupancy per Day

F Financial & Operational Measures (continued) Operational (continued): Lab – Blood Utilization Rate Lab – Single Unit Transfusions Lab – Blood Culture Contamination Rate Lab – Total Billables per Month Lab – Worked Productivity (24/7 Service) Lab – Worked Productivity (Non 24/7 Service) Lab – Paid Productivity (24/7 Service) Lab – Paid Productivity (Non 24/7 Service) Lab – Corrected Reports Lab – Specimen Rejection Rate Lab – Tests per hour worked Lab – Total direct cost per test Radiology – Tests per hour worked Radiology – Total direct cost per test Acute Care – Worked Hours per days of care Acute Care – Total direct cost per days of care Acute Care – Hospitalist or Other Provider cost per visit Acute Care – Hospitalist Cost per Acute Inpatient Day OR – Procedures per patient OR – Worked Hours per procedure OR – Total direct cost per procedure OR – Provider cost associated with CRNA or Anesthesiologist per visit ED – Hours worked per visit ED – Total direct cost per visit ED – Physician/PA/NP cost per visit 14

Financial & Operational Measures (continued) Operational (continued): Skilled Nursing Facility – Average daily census to clinical staffing ratio Skilled Nursing Facility – Base cost per patient day Skilled Nursing Facility – Support cost per patient day Skilled Nursing Facility – Support cost to base cost ratio Skilled Nursing Facility – Related support to base cost ratio limit Skilled Nursing Facility – Patient days 15

16 Web Site Access An address and password are required to enter this secure web site. The level of access is determined by the User type : System Administrator – maintains the site – KHA/KHERF State Administrator –provides support to Provider Contacts in their State Network Administrator – maintains Network profiles & provides support Provider Contact – maintains Provider profiles, adds users & enters data Provider User – enters data and runs reports View Only – views data and runs reports Report Recipient – no access to QHi, only receives reports Quality Health Indicators

17 Defining Your Hospital Return to Main Menu

18 Users navigate through the suite of resources in the PiHQ Portal by clicking on the blue-lettered links in the white menu bar

19 Hover text provides a brief description of each resource

All QHi, HSI and SQSS users have access to the PiHQ search engine.

Users type in search topic here …or on any page throughout the portal

Results are pulled from all Portal resources. Future enhancements will allow users to pull from resources outside of PiHQ as well.

The Resource Library holds all resource materials developed for PiHQ.

All users have access to the Resource Library

Results are pulled from all Portal resources. Icons identify the source of the information.

All users have access to the Calendar

The Calendar provides registration information for upcoming Quality Training Sessions

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Users with access to this application are directed to the home page, without additional log in.

All HCAHPS measures can be automatically pulled from HSI and uploaded directly into QHi, eliminating duplicate entry. Future enhancements will allow any HSI measure to be uploaded into QHi.

Users with access to this application are directed to their customized home page, without additional log in.

Partners in Healthcare Quality are working with two notable Risk Management vendors to pull aggregate data directly into QHi, further reducing data entry, and enhancing comparative analysis and benchmarking opportunities.

33 Defining Your Hospital Return to Main Menu

34 Users navigate through QHi by selecting options from the red main-menu bar and the blue sub-menu bar Click Administration to view Hospital Profile page

35 Provider Contacts are responsible for completing and maintaining the Hospital Profile page for their facility All fields with a red asterisk are required fields Hospital Characteristics define each facility for creation of peer groups when running reports

36 Click drop-down to select Level of Measurement. This applies only to Financial/Operational measures Question mark icons provide pop-up definitions throughout the QHi site

37 Selecting Measures Return to Main Menu

38 Click here or here to go to the Measure Selection page

39 Measure Sets lists the pre-determined sets of measures selected by a state or network for their hospitals to collect Click on question mark icon to display the measures included in each measure set

40 Individual measures can be selected from the list of measures in each category group. A measure or type of measure can be located by typing in a word identifier or descriptor Measure information is available by clicking on the question icon. The number of hospitals collecting each measure is also provided.

41 Entering Data Return to Main Menu

42 Click Data Submissions to access the Data Submission page

43 Click drop-down arrow to select prior months data submissions To create a new months Data Submission page, select month and year and click on Add New Submission IMPORTANT: You must check Activate data for reporting box and then Save All and Stay for the data entered this month to be displayed on dashboards and in reports Save All and Stay will only save data entered on this Data Submission page and will not forward data to dashboards and reports

44 If data for the month is entered and saved, but not activated, this message will appear to remind the user to activate the data for reporting Click here to import CMS data from your CART report Click on question icon to view information about the measure calculation and element definitions

45 Measures and their data elements automatically populate this page when measures are selected and and saved in the Measure Selection page Prior months data is displayed for easy reference Click to immediately calculate and display data results

46 The Dashboard Return to Main Menu

47 The Core Measures Dashboard displays comparison data for the eight Core Measures Roll mouse over any Dashboard graph to view the pop-up calculation for that measure The Dashboard can be displayed in graph, table, graph/table or PDF views

48 Table View

49 Graph and Table View

50 Dashboard data is calculated using a consecutive three-month summing average State Avg values reflect data from hospitals in the same state as My Hospital and reported in the same time interval QHi Avg values reflect data from all hospitals in QHi reporting the same measure in the same time interval

51 A hospital must have activated data for at least one of the three months in the Date Range in order for the measure to be displayed on the Dashboard My Hospital data for some clinical measures will not display on the Dashboard if the hospital had no occurrences during the Date Range period Financial measures on the Dashboard default to peer groups determined by the hospitals selection of level of reporting (Hospital Only or Entire Enterprise) in the Hospital Profile

52 The three months in the Date Range can be changed by clicking the drop-down to select the start month for the desired three-month period

53 Click here to view the Dashboard as a PDF

54 PDF view The PDF format allows the user to save, print or the Dashboard in graph, table or graph/table views

55 Users can the Dashboard in PDF to themselves by clicking To Myself …or choose another recipient

56 User selects from a list of existing registered users …or choose to add a new recipient

57 Enter the name and address of the new recipient …and click Add New

58 Click Create Schedule to establish a pre-determined schedule for mailing Dashboard reports to selected recipients

59 1. Select run date by clicking on calendar 2. Select frequency (monthly, quarterly, annually) 3. Select recipients 4. Click on Save Schedule 5. Report is sent through as a PDF attachment

60 Click View My Dashboard to create a customized Dashboard

61 Only those measures being collected by the hospital will be available in the list Click drop-down to select a measure to display on Dashboard Selected measures are retained and are user specific Notes section available to add comments or additional information

62 Click At A Glance Dashboard to view a twelve-month trending graph/table view of each of the eight Dashboard core measures

63 At A Glance twelve-month trending graphs for each Core measure with timeline and view options

64 Reports Return to Main Menu

65 Reports is still available to users to create peer reports. However, its function has been replaced by the enhanced and upgraded New Reports Click New Reports to view measures and create peer reports

66 Select report start and end dates Select peer groups Select data grouping

67 Users can select up to five additional peer groups

68 Available criteria selections for each peer group

69 Users can only create a report on measures that are being collected by their hospital Click on the blue measures category bar to display the list of measures (being collected by that hospital) in that category Users can select more than one measure from more than one category

70 Select output format Select how wish to view report

71 Webpage At A Glance view

72 Webpage Line Graph view

73 Webpage Bar Graph view

74 Webpage Table view The users facility is identified as Hospital

75 Webpage Table with detail view Note that peer hospitals are not identified by name but have been assigned random numbers Click on the envelope icon to contact a peer hospital for best practice information

76 The Hospital Contact at the selected peer hospital will receive the message

77 Export format applies to Table and Table with detail views

78 From the Excel report users can create customized graphs to meet their needs

79 Gray Scale format displays graphs in black and white

80 Click on Best Practice Report to view and create reports that list the top five performers for any measure in QHi

81 Hospitals can create a customized Best Practice report by selecting: 1.Comparison quarter 2.Sorting and display options 3.Criteria 4.Measures 5. Clicking on Run Report

82 Top performers are defined by the summed average of the most recent or selected quarters data Previous two quarters are displayed for reference only If your hospital is not in the top 5 performers, it will be shown at the end of the list with the ranking identified If your hospital is in the top 5 performers of a core measure, it will be identified on the Dashboard with green stars and the message: Best Practice Top Performer Click on the envelope icon to contact a top performer hospital for best practice information

83 Training, educational materials and QHi documents are available for download on the Help page

84 How we use the data Return to Main Menu

85 I print a copy of the graphs and take it to the board for discussion. They appreciate seeing in color how we compare to other CAHs in KS as well as others in the USA. On a quarterly basis I am giving a copy of the bar graphs to our Board Members at their meeting. I give the Quality Committee a copy of the quality reports on a quarterly basis. We track and present our indicators monthly and are usually above the norm. On the occasions when we fall below, it prompts us to review processes to seek improvements. If we fall below expectations, we look for ways to improve and then report back to the board in the next quarter. We like the Days in AR report. This is our only source for comparative information on this measure. Quality Health Indicators What do we do with the data? A few comments from our hospitals…

86 Thank you for viewing this demonstration. If you have any questions or would like additional information on the QHi project, please contact: Sally Perkins, QHi System Administrator or Stuart Moore, QHi Coordinator Quality Health Indicators